How should a radiofrequency (RF) burn be treated?

Treatment of Radiofrequency Burns

Radiofrequency burns should be managed as thermal burns using immediate cooling with clean running water for 5-20 minutes, followed by wound cleansing, application of a greasy emollient or petrolatum-based dressing, adequate analgesia, and close monitoring for delayed tissue injury—with specialist referral if burns are deep, involve critical anatomic areas, or fail to heal within 14 days. 1, 2, 3

Immediate First Aid Management

• Cool the burn immediately with clean running water (15-25°C) for 5-20 minutes to limit tissue damage, reduce pain, and potentially decrease the need for surgical intervention. 1, 2
• Cooling is effective for up to 3 hours after injury and should be applied as soon as possible. 1
• Never apply ice directly to the burn, as this causes additional tissue ischemia and damage. 1, 2
• Remove any jewelry or constricting items before swelling develops to prevent vascular compromise. 2

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs (ibuprofen 800 mg) for pain control, which are well-tolerated and recommended for burn-related pain. 1, 2
• For severe pain, consider titrated intravenous opioids or ketamine, as burn pain can be intense and difficult to control. 1, 4
• Provide adequate analgesia before any wound care procedures. 1, 2

Wound Cleansing and Preparation

• Clean the burn wound in a clean environment using tap water, isotonic saline, or dilute chlorhexidine solution to remove debris and foreign matter. 1, 2
• Gently irrigate with warmed sterile water or saline to avoid driving bacteria deeper into tissues. 2
• If blisters are present, leave them intact as they act as a natural biological dressing that protects the wound, reduces pain, and decreases infection risk. 2
• If blisters have ruptured, leave the overlying skin in place as a biological dressing. 2

Topical Treatment and Dressing Application

• Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over the entire burn surface, which significantly reduces complications including hypertrophic scarring compared to dry dressings. 2
• Alternative topical agents include petrolatum, petrolatum-based antibiotic ointment, medical-grade honey, or aloe vera. 1, 2
• Cover with a non-adherent dressing (such as Mepitel or Telfa) directly over the topical agent. 1, 2
• Add a secondary foam or absorbent dressing if exudate is present, changing dressings as needed. 2
• Apply dressings to approximately 1/16 inch thickness once to twice daily if using silver sulfadiazine, though avoid prolonged use on superficial burns as it may delay healing. 1, 5

Infection Prevention

• Do not apply topical antibiotics routinely; reserve antimicrobial agents only for sloughy or obviously infected wounds to prevent antimicrobial resistance. 1, 2
• Systemic antibiotic prophylaxis is not recommended routinely for burn patients. 1
• Monitor for signs of infection including increasing pain, redness extending beyond burn margins, swelling, purulent discharge, fever, or systemic signs of sepsis. 1, 2

Special Considerations for Radiofrequency Burns

• RF burns may involve deeper tissue without immediate observable skin injury or pain, creating a latent period before burns become apparent. 6
• "Hot spots" of focal necrosis may occur at tissue interfaces and in areas with poor blood supply, requiring careful monitoring over time. 6
• A follow-up physical examination is mandatory because RF burns can have delayed presentation and may worsen in appearance over the first few days. 7, 6
• The case report of a third-degree burn from cooled RF ablation demonstrates that skin blanching and severe localized pain during the procedure are warning signs requiring immediate cessation. 7

Mandatory Specialist Referral Criteria

• Refer immediately to a burn center or emergency department if burns involve the face, hands, feet, or genitals, regardless of size. 1, 2, 4
• Burns >10% total body surface area (TBSA) in adults or >5% in children require burn center evaluation. 1, 4
• All full-thickness (third-degree) burns mandate specialist evaluation. 2, 4
• Any burn that appears unlikely to heal within 14 days should be referred for specialist assessment. 3
• Signs of compartment syndrome (blue, purple, or pale extremities indicating poor perfusion) require emergency escharotomy. 1, 4

Follow-Up and Monitoring

• Re-evaluate dressings daily to detect early complications and monitor healing progress. 1
• Watch for delayed tissue injury, as RF burns can demonstrate progressive necrosis over days to weeks. 7, 6
• Continue treatment until satisfactory healing occurs or the burn site is ready for grafting. 5
• The reported case of RF burn took nearly 5 months to heal, highlighting the potential for prolonged recovery. 7

Critical Pitfalls to Avoid

• Do not delay cooling or assume the burn is minor based on initial appearance, as RF burns can have delayed presentation. 7, 6
• Do not apply butter, oil, or home remedies to burns, as this increases infection risk and delays healing. 2
• Do not completely unroof blisters, as this significantly increases infection risk. 2
• Do not use prolonged external cooling devices, as they increase the risk of hypothermia in extensive burns. 1
• Do not delay specialist referral for burns in high-risk anatomic locations or those showing signs of deep tissue involvement. 1, 2, 4